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How To File A Claim When You Have More Than One Health Insurance Coverage

When Only One Plan Requires A Co-pay

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When only one plan requires a co-pay of something like $5, $10 or $20, the other plan will never pay you more than your co-pay. There are two ways to accomplish this:

  1. Ask your doctor to bill the non-co-pay carrier (the secondary carrier if both plans require co-pays and the treatment is delivered by a doctor that is in both networks), or
  2. Pay the doctor the co-pay and get a written receipt for it and file for reimbursement yourself by doing the following:
    • Submit a claim form
    • Include a copy of the receipt for having paid the co-pay
    • Attach a cover letter. A sample cover letter is below.

If you see the doctor regularly, you may want to accumulate several co-pays and request reimbursement for them every few months rather than one at a time.



(Name of Insurance Company)
Claims Office
(Address: You can get the mailing address
either from the claim form or by calling the
number on your insurance ID card and
requesting it.)

RE: Marty Gray, Dependent spouse of Dale Gray
Your Insurance ID Number: (Usually the spouse's Social Security Number)
Your Policy Number: (from spouse's insurance ID card)
Reimbursement of Payments Made

Dear Claims Person:

I am insured under the above health insurance policy as a dependent of employee, Dale Gray.

I am also insured under my employer's group health insurance. My employer is Dax Manufacturing Co., Inc. My coverage is an HMO policy through HMO Mutual of Azusa. The group policy number is xxxxx-xxx and my insurance ID with Mutual of Azusa is XXX-XX-XXXX.

It is my understanding that HMO Mutual which covers me as an employee is primary to your company which is secondary under the Coordination of Benefits rules.

I pay a co-pay of $10.00 per visit.

I am requesting that you reimburse me for my co-pays from the savings you realize by being the Secondary carrier. Attached are copies of receipts for ten co-payments I made which total $100. Please mail the check to me as follows:

Dale Gray

If you need more information, please let me know or request it from Dr. No directly. Thank you for your prompt attention to this request.

Very truly yours,

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